I 

112TH CONGRESS 

1ST SESSION H. R. 1606 

To amend title XIX of the Social Security Act to require States to provide 

oral health services to aged, blind, or disabled individuals under the 

Medicaid Program, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 15, 2011 

Mr. ENGEL (for himself and Ms. SCHAKOWSKY) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To amend title XIX of the Social Security Act to require 

States to provide oral health services to aged, blind, 

or disabled individuals under the Medicaid Program, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Special Care Dentistry Act of 2011’’. 

6 (b) FINDINGS.—Congress finds the following: 

7 (1) According to the United States Surgeon 

8 General’s Report on Oral Health in America: 


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1 (A) No less than a silent epidemic of oral 

2 diseases is affecting our most vulnerable citi3 zens, including low income elderly, individuals 

4 with disabilities, and many members of racial 

5 and ethnic minority groups. 

6 (B) Oral diseases and conditions affect 

7 health and well-being throughout life. The bur8 den of oral problems is extensive and may be 

9 particularly severe in vulnerable populations. 

10 (C) Oral diseases and conditions are asso11 ciated with other health problems. Associations 

12 between chronic oral infections and other health 

13 problems, including diabetes, heart disease, and 

14 adverse pregnancy outcomes have been re15 ported. 

16 (2) Providing appropriate and necessary oral 

17 health benefits under Medicaid to individuals classi18 fied as aged, blind, or disabled would prevent unnec19 essary emergency room visits, hospitalizations, and 

20 downstream health care costs, reducing Medicaid 

21 spending. 

22 (3) While 28 percent of the people enrolled in 

23 Medicaid are aged, blind, or disabled, the high cost 

24 of medical expenditures for these populations conVerDate Mar 15 2010 23:36 Apr 20, 2011 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1606.IH H1606

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1 sumes 72 percent of the total Medicaid budget. This 

2 is not the case with dental benefits. 

3 (4) For the aged, blind, or disabled, oral health 

4 services are deemed ‘‘optional’’ by the Federal Gov5 ernment and most States provide little to no Med6 icaid coverage for these services. Many of these vul7 nerable citizen’s mouths are infected with no hope of 

8 receiving access to even basic dental care. 

9 (5) In 2003, adult aged, blind, and disabled 

10 Medicaid recipients received basic oral health serv11 ices in only 6 States (Connecticut, New Jersey, New 

12 York, North Dakota, Pennsylvania, and Wisconsin). 

13 (6) Appropriate and necessary oral health serv14 ices for adult aged, blind, and disabled people will 

15 help reduce not only Medicaid costs for these popu16 lations, but also downstream Medicare expenditures, 

17 which together total almost $600,000,000,000 annu18 ally. 

19 (7) Dental office overhead averages over 65 

20 percent. Unfortunately, Medicaid reimbursement 

21 rates fall far short of covering these expenses. 

22 (8) Additional Federal investment for the deliv23 ery of oral health services is needed to ensure vul24 nerable adults receive oral health benefits. 


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1 (9) Investments are needed for an oral health 

2 initiative to reduce the profound disparities in oral 

3 health by improving the health status of vulnerable 

4 populations to the level of health status that is en5 joyed by the majority of Americans. 

6 SEC. 2. REQUIREMENT TO PROVIDE AGED, BLIND, OR DIS7 ABLED INDIVIDUALS WITH ORAL HEALTH 

8 SERVICES UNDER THE MEDICAID PROGRAM. 

9 (a) IN GENERAL.—Title XIX of the Social Security 

10 Act (42 U.S.C. 1396 et seq.) is amended by inserting after 

11 section 1943 the following new section: 

12 ‘‘ORAL HEALTH SERVICES FOR AGED, BLIND, OR

13 DISABLED INDIVIDUALS

14 ‘‘SEC. 1944. (a) SERVICES UNDER A STATE ADULT

15 DENTAL PROGRAM FOR AGED, BLIND, OR DISABLED IN16 DIVIDUALS.—A State shall provide oral health coverage 

17 for aged, blind, or disabled individuals described in sub18 section (b) through a separate State adult dental program. 

19 The State shall demonstrate that the services and fees 

20 provided and program requirements under this section are 

21 at least equivalent to the services, fees, and requirements 

22 that are provided to children under this title and include 

23 age-appropriate services for such individuals, and that the 

24 services are provided at intervals to determine the exist25 ence of a suspected illness or condition consistent with rea26 sonable standards of dental practice (taking into account 


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1 the increased needs and oral health complexities of the 

2 population) as determined by the Secretary after consulta3 tion with national professional dental organizations. 

4 ‘‘(b) AGED, BLIND, OR DISABLED INDIVIDUALS DE5 SCRIBED.—For purposes of subsection (a), an aged, blind, 

6 or disabled individual described in this subsection is an 

7 individual— 

8 ‘‘(1) who is eligible for medical assistance under 

9 subclause (I) or (II) of section 1902(a)(10)(A)(i) 

10 (but only, in the case of subclause (I), with respect 

11 to an individual who is so eligible on the basis of re12 ceiving aid or assistance under any plan of the State 

13 approved under title I, X, XIV, or XVI); and 

14 ‘‘(2) who would be considered an aged, blind, or 

15 disabled individual under section 1614 (without re16 gard to whether the individual satisfies the income 

17 and resource requirements for receiving supple18 mental security income benefits under title XVI) and 

19 is otherwise eligible for medical assistance under the 

20 State plan or under a waiver of such plan. 

21 ‘‘(c) TRANSPORTATION.—The State shall provide 

22 transportation for aged, blind, or disabled individuals de23 scribed in subsection (b) to dental offices, hospitals, clin24 ics, or other treatment centers for the provision of oral 

25 health services to the same extent that transportation is 


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1 provided under the State plan for children eligible for 

2 medical assistance.’’. 

3 (b) DEFINITION OF ORAL HEALTH SERVICES.— 

4 (1) IN GENERAL.—Section 1905 of the Social 

5 Security Act (42 U.S.C. 1396d) is amended— 

6 (A) in subsection (a), by amending para7 graph (10) to read as follows: 

8 ‘‘(10) oral health services (as defined in sub9 section (ee)); and’’; and 

10 (B) by adding at the end the following: 

11 ‘‘(ee)(1) For purposes of this title, the term ‘oral 

12 health services’ means— 

13 ‘‘(A) relief of pain and infections; 

14 ‘‘(B) restoration or replacement of teeth; 

15 ‘‘(C) periodontal treatment; 

16 ‘‘(D) dental health preventive services, including 

17 adult fluoride application; 

18 ‘‘(E) in-patient and out-patient dental surgical, 

19 evaluation, and examination services; 

20 ‘‘(F) dentures or partial denture care; 

21 ‘‘(G) per patient house call and long term care 

22 facility visits; 

23 ‘‘(H) sedation and anesthesia; and 

24 ‘‘(I) behavior management services. 

25 ‘‘(2) For the purpose of this subsection: 


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1 ‘‘(A) The term ‘long term care facility’ means— 

2 ‘‘(i) a nursing facility; 

3 ‘‘(ii) an assisted living facility or a resident 

4 care program facility (as such terms are defined 

5 by the Secretary); 

6 ‘‘(iii) a board and care facility (as defined 

7 in section 1903(q)(4)(B), including a mental re8 tardation group home); 

9 ‘‘(iv) an intermediate care facility for the 

10 mentally retarded; and 

11 ‘‘(v) any other facility that is licensed or 

12 certified by the State and is determined appro13 priate by the Secretary, such as a community 

14 mental health center that meets the require15 ments of section 1913(c) of the Public Health 

16 Service Act, a psychiatric health facility, and a 

17 mental health rehabilitation center. 

18 ‘‘(B) The term ‘house call’ means the delivery 

19 of dental services in long term care facilities needed 

20 to overcome mobility impairments and transpor21 tation barriers. 

22 ‘‘(C) The term ‘behavior management’ means 

23 services needed to accommodate physical or behav24 ioral impairment.’’. 

25 (c) CONFORMING AMENDMENTS.— 


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1 (1) TERMINOLOGY.—Section 

2 1902(a)(43)(D)(iii) of the Social Security Act (42 

3 U.S.C. 1396a(a)(43)(D)(iii)) is amended by striking 

4 ‘‘dental’’ and inserting ‘‘oral health’’ each place it 

5 appears. 

6 (2) STATE PLAN.—Section 1902(a) of such Act 

7 (42 U.S.C. 1396a(a)) is amended— 

8 (A) in paragraph (82), by striking ‘‘and’’ 

9 at the end; 

10 (B) in paragraph (83), by striking the pe11 riod at the end and inserting ‘‘; and’’; and 

12 (C) by inserting after paragraph (83) the 

13 following: 

14 ‘‘(84) provide for— 

15 ‘‘(A) making oral health services available 

16 to aged, blind, or disabled individuals described 

17 in subsection (b) of section 1944 in accordance 

18 with the requirements of that section; 

19 ‘‘(B) informing all persons in the State 

20 who are aged, blind, or disabled and have been 

21 determined to be eligible for medical assistance 

22 including oral health services (as defined in sec23 tion 1905(ee)), of the availability of such serv24 ices; 


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1 ‘‘(C) providing or arranging for the provi2 sion of such services in all cases where they are 

3 requested; 

4 ‘‘(D) arranging for (directly or through re5 ferral to appropriate agencies, organizations, or 

6 individuals) corrective treatment the need for 

7 which is disclosed by such services; and 

8 ‘‘(E) reporting to the Secretary (in a uni9 form form and manner established by the Sec10 retary, by aged, blind, or disabled group and by 

11 basis of eligibility for medical assistance, and by 

12 not later than April 1 after the end of each fis13 cal year, beginning with fiscal year 2012) the 

14 information relating to oral health services pro15 vided under the plan during each fiscal year 

16 consisting of— 

17 ‘‘(i) the number of aged, blind, or dis18 abled individuals who reside in the State; 

19 ‘‘(ii) the number of aged, blind, or 

20 disabled individuals provided oral health 

21 services; 

22 ‘‘(iii) the number of such individuals 

23 referred for corrective treatment (the need 

24 for which is disclosed by such services); 


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1 ‘‘(iv) the amount of, and type of, pre2 ventive oral health services needed and 

3 provided; 

4 ‘‘(v) the amount of, and type of, sur5 gical restorative oral health services needed 

6 and provided; and 

7 ‘‘(vi) the amount of, and type of, 

8 other oral health services needed and pro9 vided, disaggregated into whether the serv10 ices were— 

11 ‘‘(I) emergency; 

12 ‘‘(II) preventive; 

13 ‘‘(III) surgical; 

14 ‘‘(IV) restorative; 

15 ‘‘(V) periodontal; 

16 ‘‘(VI) endodontic; or 

17 ‘‘(VII) prosthodontic.’’. 

18 (3) NURSING FACILITIES.—Section 

19 1919(b)(4)(A)(vi) of such Act (42 U.S.C. 

20 1396r(b)(4)(A)(vi)) is amended by inserting, ‘‘oral 

21 health services (as defined in section 1905(ee)) for 

22 an aged, blind, or disabled individual described in 

23 section 1944(b) who is a resident of the nursing fa24 cility,’’ after ‘‘plan)’’. 


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1 (d) FEDERAL FUNDING FOR COST OF COVERING

2 AGED, BLIND, OR DISABLED.—Section 1905 of the Social 

3 Security Act (42 U.S.C. 1396d), as amended by sub4 section (b)(1), is amended— 

5 (1) in subsection (b), in the first sentence, by 

6 inserting ‘‘subsection (ee) and’’ before ‘‘section 

7 1933(d)’’; and 

8 (2) by adding at the end the following new sub9 section: 

10 ‘‘(ff) INCREASED FMAP FOR MEDICAL ASSISTANCE

11 FOR AGED, BLIND, AND DISABLED INDIVIDUALS.—The 

12 Federal medical assistance percentage determined for a 

13 State that is one of the 50 States or the District of Colum14 bia for each fiscal year with respect to amounts expended 

15 for medical assistance for aged, blind and disabled individ16 uals described in section 1944(b) shall be equal to 100 

17 percent.’’. 

18 (e) EFFECTIVE DATE.— 

19 (1) IN GENERAL.—Except as provided in para20 graph (2), the amendments made by this section 

21 shall apply to calendar quarters beginning on or 

22 after October 1, 2011, without regard to whether or 

23 not final regulations to carry out such amendments 

24 have been promulgated by such date. 


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1 (2) DELAY PERMITTED FOR STATE PLAN

2 AMENDMENT.—In the case of a State plan for med3 ical assistance under title XIX of the Social Security 

4 Act which the Secretary of Health and Human Serv5 ices determines requires State legislation (other than 

6 legislation appropriating funds) in order for the plan 

7 to meet the additional requirements imposed by the 

8 amendments made by this section, the State plan 

9 shall not be regarded as failing to comply with the 

10 requirements of such title solely on the basis of its 

11 failure to meet these additional requirements before 

12 the first day of the first calendar quarter beginning 

13 after the close of the first regular session of the 

14 State legislature that begins after the date of enact15 ment of this Act. For purposes of the previous sen16 tence, in the case of a State that has a 2-year legis17 lative session, each year of such session shall be 

18 deemed to be a separate regular session of the State 

19 legislature. 

Æ 


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